When you have a movement disorder such as Parkinson’s disease or essential tremor, simple tasks can be excruciatingly difficult. Medication and lifestyle changes can often control your symptoms, but when those no longer help your neurologist may suggest interventional treatment.

Neurologists, neurosurgeons and other movement disorder specialists in the Sutter Health network have the expertise, compassion and technology to help preserve your motor control and overall quality of life. Interventional procedures to ease your symptoms often include ablative surgery or deep brain stimulation.

Ablative Surgery

There are a few types of ablative surgical procedures that focus on different areas of the brain, but each surgery uses a heated or cryogenic probe or electrode to destroy problematic tissue. A thalamotomy is an ablative surgery used to destroy the thalamus, which regulates voluntary motor control. During a subthalamotomy, the subthalamus is destroyed in an effort to improve motor function. A pallidotomy procedure creates scar tissue on the globus pallidus, which is often overactive in Parkinson’s disease patients and limits the brain’s ability to control movement.

During these procedures, your surgeon administers a local anesthetic, which allows you to stay awake during the surgery and not feel any pain. Staying awake allows your medical team to interact with you and make sure the correct part of your brain is being targeted. Your surgeon then applies anesthetic medicine to your scalp and drills a small hole in your skull. Note that you don’t need an anesthetic in your brain as the brain has no pain receptors. Once the area of the brain is treated using the ablative probe, your surgeon removes the probe and closes the drill sites.

Deep Brain Stimulation

Deep brain stimulation delivers electrical pulses directly to the brain via a small, battery-powered device that can block abnormal nerve signals that cause tremors. The surgical procedure is typically performed in two phases.

During the first phase, your surgeon places electrodes in your brain via a craniotomy. As with the ablative procedures, you are given a local anesthetic, which allows you to stay awake during the surgery and not feel any pain. Using a medical drill, your doctor makes a small hole in your skull through which an electrode is placed directly into a specific area of your brain. Your surgeon sends electrical pulses to the electrodes to make sure they are in the area of your brain that causes tremors. Once the electrodes are in the proper place, your surgeon closes the drill sites.

You may proceed directly to the second phase of surgery or your pulse-generating device may be implanted up to two weeks later. Your doctor will work with you to discuss the best option.

During the second phase, your surgeon places you under general anesthesia, which allows you to sleep during the surgery. Once you are unconscious, your doctor makes a small incision in the left side of your chest or upper abdomen and places the pulse-generating device, about the size of a stopwatch, in a surgically-created pocket underneath your skin. A connecting wire of electrodes runs underneath your skin from the pulse-generating device to the electrodes in your brain. After implantation, your doctor either immediately programs the device to generate pulses of electricity at intervals specific to your needs, or does so at a future appointment. The pulses can be adjusted by your doctor and you can use a handheld magnet to turn the device on and off.